Hyperechogenic signal from the pericardium after vaccination against SARS-CoV-2

Q4 Medicine

Infektsionnye Bolezni Pub Date : 2021-01-01 DOI:10.20953/1729-9225-2021-4-43-50

Z. Sukmarova, Y. Ovchinnikov, G. Gudima, F. M. Ibragimova, O. V. Afonina, K.E. Machkalyan

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Inclusion criteria: The patient’s consent, the intention to be vaccinated against SARS-CoV-2, no confirmation and suspicions about COVID-19 in the past, unchanged pericardium as of Visit 0, as well as no diseases which may cause any changes in the pericardium throughout the time of the study. Exclusion criteria: SARS-CoV-2 infection during the study, refusal or any impossibility to make more as 1 scheduled visit for check-up. Echocardiography was performed according to a standardized protocol at unchanged brightness settings with a focus on the pericardium in dynamics: before the vaccination (Visit 0), within a week after the first dose (Visit 1) and the second dose (Visit 2), and in a month (Visit 3), 2 months (Visit 4), 3 months (Visit 5) and 4 months (Visit 6) after the latest dose of the vaccine. Complete venous blood count with a leucogram and determination of the erythrocyte sedimentation rate was performed at visits 0 and 2. Results. 52 patients completed their participation in the study. Low-intensity changes in the pericardium after the first dose of the vaccine were found in 67% of patients. Ultrasound changes arose as a more enhanced echocardiographic signal in the basal segments of the inferolateral area in 57%, spread up to the basal segment of the anterior lateral area in 13%, the area around the atria in 15%. Pericardial layer separation for 3 and more mm was found in 23%. After the second dose of the vaccine was administered, 74% demonstrated the enhancement of the pericardium, including signs of minor effusion in 20% of patients. The pericardium image got slightly less bright in 4 ± 1 weeks after the second dose: up to the conditional normal state (the visual quality of the pericardium in a specific person as of visit 0) in 2 patients. However, the pericardium remained brighter in 71%, with the minimal effusion in 1 patient. 68% of patients demonstrated the pathological TTE image in the 8th week after the vaccination, with effusion being discovered in 2% of patients. The hyperechogenity of the pericardium was detected in 66% in 12 ± 1 weeks, without effusion being found. The pericardium still remained brighter in 16 ± 1 weeks in 7% of patients than it was before the vaccination. Low-intensity pericardial chest pain is detected only with active questioning and is recorded in up to 8% of cases in the first 4 days after the administration of the 1st and /or 2nd doses of the vaccine, did not correlate with the duration of hyperechogenity, but did- with exudation: r = 0,22 (p = 0,05). Of the analyzed blood parameters, an increase in the percentage of neutrophils by 2.8% was registered after vaccination, the increase in their proportion correlated with the presence of a combined point, including any of the considered echo parameters of the pericardium, at visit 2: r = 0.5, p < 0, 05; in 6% of patients, neutrophils exceeded normal values. Also, after vaccination, the erythrocyte sedimentation rate significantly increased (on average, by 4.2 mm/h), which correlated with the presence of a combined point of pericardial changes (r = 0.6, p < 0.05). The erythrocyte sedimentation rate threshold was exceeded in 12% of the subjects: all of them had a recorded effusion according to echocardiography. The appearance of band forms neutrophils by 1 week after the administration of the 2nd dose of the vaccine was registered in 50% of patients. None of the observed required hospitalization and died. Conclusion. The overwhelming majority of patients demonstrated the TTE phenomenon of the enhanced or effused pericardium as a result of the vaccination. Minimal changes completely disappeared in 4 months. The presence of ultrasound changes in the pericardium correlates with an increase in erythrocyte sedimentation rate and / or the proportion of neutrophils is accompanied by a stab shift in 50% of the analyzes. We believe more aimed research is needed to evaluate systemic effects of virus antigens on the body. Drawing upon the experience of the center, the above TTE changes are much less intense in terms of TTE signs than it happens after contacting a live pathogen. 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引用次数: 2

Abstract

The full-scale syndrome of pericarditis or subclinical changes in pericardium, as seen during transthoracic echocardiography, are detected in large number of patients with COVID-19 or or those who have recovered from COVID-19, and can persevering for about a year. There is a significant accumulation of reported cases of pericarditis following vaccination against SARS-CoV-2. Questions remain about subclinical pericardial involvement in vaccinated patients. The study is aimed to examine pericardial changes through transthoracic echocardiography in patients vaccinated against SARS-CoV-2, and describe their dynamics and compare the ultrasound views with symptoms and inflammatory changes in blood tests. Methods. Inclusion criteria: The patient’s consent, the intention to be vaccinated against SARS-CoV-2, no confirmation and suspicions about COVID-19 in the past, unchanged pericardium as of Visit 0, as well as no diseases which may cause any changes in the pericardium throughout the time of the study. Exclusion criteria: SARS-CoV-2 infection during the study, refusal or any impossibility to make more as 1 scheduled visit for check-up. Echocardiography was performed according to a standardized protocol at unchanged brightness settings with a focus on the pericardium in dynamics: before the vaccination (Visit 0), within a week after the first dose (Visit 1) and the second dose (Visit 2), and in a month (Visit 3), 2 months (Visit 4), 3 months (Visit 5) and 4 months (Visit 6) after the latest dose of the vaccine. Complete venous blood count with a leucogram and determination of the erythrocyte sedimentation rate was performed at visits 0 and 2. Results. 52 patients completed their participation in the study. Low-intensity changes in the pericardium after the first dose of the vaccine were found in 67% of patients. Ultrasound changes arose as a more enhanced echocardiographic signal in the basal segments of the inferolateral area in 57%, spread up to the basal segment of the anterior lateral area in 13%, the area around the atria in 15%. Pericardial layer separation for 3 and more mm was found in 23%. After the second dose of the vaccine was administered, 74% demonstrated the enhancement of the pericardium, including signs of minor effusion in 20% of patients. The pericardium image got slightly less bright in 4 ± 1 weeks after the second dose: up to the conditional normal state (the visual quality of the pericardium in a specific person as of visit 0) in 2 patients. However, the pericardium remained brighter in 71%, with the minimal effusion in 1 patient. 68% of patients demonstrated the pathological TTE image in the 8th week after the vaccination, with effusion being discovered in 2% of patients. The hyperechogenity of the pericardium was detected in 66% in 12 ± 1 weeks, without effusion being found. The pericardium still remained brighter in 16 ± 1 weeks in 7% of patients than it was before the vaccination. Low-intensity pericardial chest pain is detected only with active questioning and is recorded in up to 8% of cases in the first 4 days after the administration of the 1st and /or 2nd doses of the vaccine, did not correlate with the duration of hyperechogenity, but did- with exudation: r = 0,22 (p = 0,05). Of the analyzed blood parameters, an increase in the percentage of neutrophils by 2.8% was registered after vaccination, the increase in their proportion correlated with the presence of a combined point, including any of the considered echo parameters of the pericardium, at visit 2: r = 0.5, p < 0, 05; in 6% of patients, neutrophils exceeded normal values. Also, after vaccination, the erythrocyte sedimentation rate significantly increased (on average, by 4.2 mm/h), which correlated with the presence of a combined point of pericardial changes (r = 0.6, p < 0.05). The erythrocyte sedimentation rate threshold was exceeded in 12% of the subjects: all of them had a recorded effusion according to echocardiography. The appearance of band forms neutrophils by 1 week after the administration of the 2nd dose of the vaccine was registered in 50% of patients. None of the observed required hospitalization and died. Conclusion. The overwhelming majority of patients demonstrated the TTE phenomenon of the enhanced or effused pericardium as a result of the vaccination. Minimal changes completely disappeared in 4 months. The presence of ultrasound changes in the pericardium correlates with an increase in erythrocyte sedimentation rate and / or the proportion of neutrophils is accompanied by a stab shift in 50% of the analyzes. We believe more aimed research is needed to evaluate systemic effects of virus antigens on the body. Drawing upon the experience of the center, the above TTE changes are much less intense in terms of TTE signs than it happens after contacting a live pathogen. Therefore, it can definitely be more preferable than “natural” immunization due to illness Key words: COVID-19, complications, echocardiography, pericarditis, vaccination

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接种SARS-CoV-2疫苗后心包的高回声信号

经胸超声心动图显示的全面心包炎综合征或心包膜亚临床改变，在大量的COVID-19患者或COVID-19康复者中发现，并可持续约一年。在接种SARS-CoV-2疫苗后，报告的心包炎病例显著增加。接种疫苗患者的亚临床心包受累问题仍然存在。本研究旨在通过经胸超声心动图检查接种SARS-CoV-2疫苗的患者心包改变，描述其动态变化，并将超声图像与血液检查的症状和炎症变化进行比较。方法。纳入标准:患者同意，有接种SARS-CoV-2疫苗的意向，既往无COVID-19的确诊和怀疑，在第0次就诊时心包未改变，以及在整个研究过程中没有可能导致心包改变的疾病。排除标准:研究期间感染SARS-CoV-2，拒绝或不可能进行1次以上的预约检查。超声心动图按照标准化方案在不变亮度设置下进行，重点是心包动力学:在接种疫苗前(就诊0)，在第一剂(就诊1)和第二剂(就诊2)后一周内，以及在最后一次接种疫苗后一个月(就诊3)，2个月(就诊4)，3个月(就诊5)和4个月(就诊6)。在第0次和第2次就诊时进行全静脉血计数和白细胞图和红细胞沉降率测定。结果:52例患者完成了研究。67%的患者在接种第一剂疫苗后心包出现低强度改变。超声改变表现为超声心动图信号在外侧内区基底段增强(57%)，向前外侧区基底段扩散(13%)，心房周围区扩散(15%)。心包层分离3 mm及以上者占23%。在接种第二剂疫苗后，74%的患者心包增强，包括20%的患者有轻微积液的迹象。第二次给药后4±1周心包图像亮度略有下降:2例患者达到条件正常状态(就诊0时特定患者心包视觉质量)。然而，71%的患者心包仍然明亮，1例患者有少量积液。68%的患者在接种疫苗后第8周出现病理性TTE图像，2%的患者发现积液。66%的患者在12±1周内发现心包高回声，未见积液。在16±1周内，7%的患者心包仍比接种前明亮。低强度心包胸痛只有在主动询问时才能检测到，在接种第一剂和/或第二剂疫苗后的头4天内，高达8%的病例记录了低强度心包胸痛，与高回声的持续时间无关，但与渗出有关:r = 0.22 (p = 0.05)。在分析的血液参数中，接种疫苗后中性粒细胞百分比增加了2.8%，其比例的增加与就诊2时合并点的存在相关，包括任何考虑的心包回声参数:r = 0.5, p < 0.05;6%的患者中性粒细胞超过正常值。此外，接种疫苗后，红细胞沉降率显著增加(平均4.2 mm/h)，这与心包改变合并点的存在相关(r = 0.6, p < 0.05)。12%的受试者红细胞沉降率超过阈值，超声心动图均有积液记录。50%的患者在接种第二剂疫苗1周后出现带状中性粒细胞。观察到的患者均无需住院治疗并死亡。结论。绝大多数患者由于接种疫苗而表现出心包增强或积液的TTE现象。最小的变化在4个月内完全消失。心包超声变化的存在与红细胞沉降率和/或中性粒细胞比例的增加相关，在50%的分析中伴有刺移。我们认为需要更多有针对性的研究来评估病毒抗原对人体的全身影响。根据该中心的经验，就TTE体征而言，上述TTE变化远不如接触活病原体后发生的剧烈。经胸超声心动图显示的全面心包炎综合征或心包膜亚临床改变，在大量的COVID-19患者或COVID-19康复者中发现，并可持续约一年。在接种SARS-CoV-2疫苗后，报告的心包炎病例显著增加。接种疫苗患者的亚临床心包受累问题仍然存在。本研究旨在通过经胸超声心动图检查接种SARS-CoV-2疫苗的患者心包改变，描述其动态变化，并将超声图像与血液检查的症状和炎症变化进行比较。方法。纳入标准:患者同意，有接种SARS-CoV-2疫苗的意向，既往无COVID-19的确诊和怀疑，在第0次就诊时心包未改变，以及在整个研究过程中没有可能导致心包改变的疾病。排除标准:研究期间感染SARS-CoV-2，拒绝或不可能进行1次以上的预约检查。超声心动图按照标准化方案在不变亮度设置下进行，重点是心包动力学:在接种疫苗前(就诊0)，在第一剂(就诊1)和第二剂(就诊2)后一周内，以及在最后一次接种疫苗后一个月(就诊3)，2个月(就诊4)，3个月(就诊5)和4个月(就诊6)。在第0次和第2次就诊时进行全静脉血计数和白细胞图和红细胞沉降率测定。结果:52例患者完成了研究。67%的患者在接种第一剂疫苗后心包出现低强度改变。超声改变表现为超声心动图信号在外侧内区基底段增强(57%)，向前外侧区基底段扩散(13%)，心房周围区扩散(15%)。心包层分离3 mm及以上者占23%。在接种第二剂疫苗后，74%的患者心包增强，包括20%的患者有轻微积液的迹象。第二次给药后4±1周心包图像亮度略有下降:2例患者达到条件正常状态(就诊0时特定患者心包视觉质量)。然而，71%的患者心包仍然明亮，1例患者有少量积液。68%的患者在接种疫苗后第8周出现病理性TTE图像，2%的患者发现积液。66%的患者在12±1周内发现心包高回声，未见积液。在16±1周内，7%的患者心包仍比接种前明亮。低强度心包胸痛只有在主动询问时才能检测到，在接种第一剂和/或第二剂疫苗后的头4天内，高达8%的病例记录了低强度心包胸痛，与高回声的持续时间无关，但与渗出有关:r = 0.22 (p = 0.05)。在分析的血液参数中，接种疫苗后中性粒细胞百分比增加了2.8%，其比例的增加与就诊2时合并点的存在相关，包括任何考虑的心包回声参数:r = 0.5, p < 0.05;6%的患者中性粒细胞超过正常值。此外，接种疫苗后，红细胞沉降率显著增加(平均4.2 mm/h)，这与心包改变合并点的存在相关(r = 0.6, p < 0.05)。12%的受试者红细胞沉降率超过阈值，超声心动图均有积液记录。50%的患者在接种第二剂疫苗1周后出现带状中性粒细胞。观察到的患者均无需住院治疗并死亡。结论。绝大多数患者由于接种疫苗而表现出心包增强或积液的TTE现象。最小的变化在4个月内完全消失。心包超声变化的存在与红细胞沉降率和/或中性粒细胞比例的增加相关，在50%的分析中伴有刺移。我们认为需要更多有针对性的研究来评估病毒抗原对人体的全身影响。根据该中心的经验，就TTE体征而言，上述TTE变化远不如接触活病原体后发生的剧烈。因此，由于疾病，它肯定比“自然”免疫更有利。关键词:COVID-19，并发症，超声心动图，心包炎，疫苗接种因此，由于疾病，它肯定比“自然”免疫更有利。关键词:COVID-19，并发症，超声心动图，心包炎，疫苗接种

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来源期刊

Infektsionnye Bolezni Medicine-Infectious Diseases

CiteScore

1.30

自引率

0.00%

发文量

期刊介绍： The journal publishes original research works, reviews of literature, lectures, methodological recommendations, clinical observations. Main topics: problems of etiology, pathogenesis, clinical manifestations of infectious diseases, new techniques and methods of their diagnosis, prevention and treatment; special attention is paid to the problems of antibacterial and antiviral therapy, the use of immunoglobulins and interferons, and also to intensive therapy of critical states. The journal is in the List of leading scientific journals and periodicals of the Supreme Attestation Committee, where the principal results of doctoral dissertations should be published.